Provider Demographics
NPI:1538557947
Name:KEENAN, CARINE M (LMFT)
Entity type:Individual
Prefix:
First Name:CARINE
Middle Name:M
Last Name:KEENAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20300 VENTURA BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2448
Mailing Address - Country:US
Mailing Address - Phone:818-912-9189
Mailing Address - Fax:
Practice Address - Street 1:20300 VENTURA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2448
Practice Address - Country:US
Practice Address - Phone:818-912-9189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 80427106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA106H00000XOtherTAXONOMY